How Do You Fix a Nose with a Bulbous Tip?

How is excess tissue removed from the tip of the nose?

Doctor Answers 29

Define the tip with sutures and cartilage to fix a bulbous tip

A bulbous tip is caused by wide cartilages that are poorly shaped. Converting a bulbous tip to a more shapely and defined tip requires Carving the cartilages to a more slender shape and then suturing (connecting them with surgical threads) them together To narrow them and further refine their shape while also maintaining their strength and integrity. One of the biggest limitations to a more defined tip is simply the skin. Unfortunately, we can make the inside of the nose as small as possible but the Overlying skin needs to contract around the cartilage underneath. If it doesn't, the nose continues to look on shapely, much like wearing an extra-large sweater after losing 40 pounds.


New York Facial Plastic Surgeon
4.6 out of 5 stars 69 reviews

Usually, nose tissue is not removed but reshaped

Removing tissue from the tip of the nose for a bulbous tip is actually a risky maneuver. This can devascularize the tip and lead to skin death at the tip of the nose. Most of the time, cartilage reshaping can do wonders to narrow the tip even in the Asian nose.

Many believe in the surgical community, that the nasal tip of the ethnic nose is mostly fat and thick skin. This is true to an extent but with proper shaping of the cartilage siginificant changes can be made to the tip and the bulbous tip especially. The only way to know if to have us look at it closely and examined. Open techniques are also a more accurate way to shape the nose.

Philip Young, MD
Bellevue Facial Plastic Surgeon
3.9 out of 5 stars 64 reviews

Bulbous Noses Require Cartilage Fix

Rhinoplasty is one of the most difficult facial plastic surgery procedures and refining the tip is the most complex part of rhinoplasty. In the case of a bulbous nose tip, this can be caused by a variety of factors, but usually starts with cartilage that is broad and too widely spaced. I would usually approach this is an open manner, shave down the cartilage and suture it together. If the overlying skin is very thick, it will need to be thinned.  At times the cartilage is mal positioned and overly curved.  In this case, the cartilage will need to be reoriented and straightened with cartilage grafting. The exact procedures necessary will depend on the patient's anatomy and what he or she hopes to achieve. Whether the patient is Caucasian, African-American, Asian, or another ethnicity may also influence the surgery, as anatomy and cartilage composition can vary considerably among the races. Please find a facial plastic surgeon with expertise in tip anatomy. I hope this helps.

Repair of a bulbous nasal tip is commonly performed during rhinoplasty surgery.

We prefer an open approach, and tip narrowing in our practice typically involves dividing the lower lateral cartilages, and trimming excessive tip cartilage that may be leading to a bulbous appearance.Hope this helps.Dr Joseph

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 396 reviews

Bulbous Tip

A rhinoplasty (nose reshaping surgery) is appropriate to address a bulbous nasal tip. Most likely, an “open rhinoplasty” (where the soft tissues are gently elevated to allow direct access to the tip cartilages) will be required.

Anand G. Shah, MD
San Antonio Facial Plastic Surgeon
4.5 out of 5 stars 12 reviews

Rhinoplasty for bulbous tip

The tip of the nose is shaped by the lower lateral cartilages - there are two of them and they are relative mirror images of each other. A bulbous nasal tip typically has diverging cartilages that are wide in the lateral zones. A rhinoplasty procedure will narrow the width of the cartilages, unite them together and improve their projection out of the facial plane.

Rhinoplasty for Bulbous Tip

                  A bulbous nasal tip can occur for a variety of reasons. The majority of cases are related to excess nasal cartilage, widely separated nasal cartilage and thickened nasal tip soft tissue.

                  The treatment of this condition depends on the underlying anatomic deformity. For this reason a careful evaluation of the nasal anatomy should be undertaken before proceeding with correction.

                  In some cases reshaping of the nasal tip may involve trimming the lower lateral cartilages. In other cases the nasal tip may be reshaped by sewing the nasal cartilages together to minimize the nasal tip width. Finally, in some cases thinning of the nasal soft tissue may be necessary.

                  It’s important to individualize treatment based on the patient’s unique anatomic findings and aesthetic goals. For this reason, consultation with a board certified plastic surgeon with rhinoplasty experience is essential. 

Bulbous tip

Hi,

There are actually several types of bulbous tips. The is a cartilagenous bulbous tip which typically occurs in caucasion patients. This requires resculpting or reshaping the tip cartilages to a more aquiline or structured look. The second kind of bulbous tip is a fatty bulbous tip which is typically seen in ethnic patients ( African Americans, Hispanics and Asian). These noses require not only cartilage grafting to the tip but also defatting of the tip thereby thinning the  subcutaneous skin. The third type of bulbous tip is a result of scar tissue build up from a previous rhinoplasty which requires removal of the scar tissue and possible cartilage grafts. See link for more explanation.

Best,

Dr.S.

 

Oleh Slupchynskyj, MD, FACS
New York Facial Plastic Surgeon
4.8 out of 5 stars 265 reviews

The Primary Problem With A Bulbous Tip Is Excess Cartilage With A Suboptimal Shape.

The primary cause of a bulbous tip is excess cartilage that creates a sub-optimal shape. The procedure involves careful cartilage removal and reshaping. It is important to leave a strong framework in order to prevent collapse.  Some patients also have excess fatty tissue, which can be thinned out. However, overly aggressive soft-tissue thinning can impair blood supply, which can lead to severe complications.

Closed rhinoplasty and refining a bulbous tip

I have a different take then others that have posted.  I see very few indications to ever performing an 'open rhinoplasty.'  While the difference between an open rhinoplasty and closed rhinoplasty is only a few millimeters of tissue that is preserved or cut, it is very important tissue.  Inside the columella there are important arteries and veins and preservation of these vessels makes maneuvers like debulking the tip much safer and sppeds healing recovery and resolution of swelling.  Perhaps more important are the aesthetic ramifications.  When dealing with a bulbous tip usually a combination of maneuvers is indicated.  One must debulk the soft tissue, trim the lower lateral cartilage, remove interalar tissue, suture the lower lateral cartilages together to refine and define the tip +/- a complex arangement of cartilage grafts to restore aesthetic dimensions.  To get a true idea of the result that a surgeons maneuvers are having, the columella and its natural tensions must be present.  This is near impossible to do with a divided columella in open rhinoplasty so it is much harder to judge the result of the underlying structure.  I recommend finding a surgeon comfortable operating in a closed technique.

All the best,

Rian A. Maercks M.D.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.